Results: 15

Autism spectrum disorders (ASD) are characterised by problems with social interaction and communication, as well as repetitive behaviours and limited activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that are sometimes given to reduce anxiety or obsessive‐compulsive behaviours. We found nine trials, involving 320 people, which evaluated four SSRIs: fluoxetine, fluvoxamine, fenfluramine and citalopram. Five studies included only children and four studies included only adults. One trial enrolled 149 children, but the other trials were much smaller. We found no trials that evaluated sertraline, paroxetine or escitalopram. There is no evidence to support the use of SSRIs to treat autism in children. There is limited evidence, which is not yet sufficiently robust, to suggest effectiveness of SSRIs in adults with autism. Treatment with an SSRI may cause side effects. Decisions about the use of SSRIs for established clinical indications that may co‐occur with autism, such as obsessive‐compulsive disorder and depression in adults or children, and anxiety in adults, should be made on a case‐by‐case basis.

This guideline has been developed to advise on the identification, treatment and management of the eating disorders anorexia nervosa, bulimia nervosa and related conditions. The guideline recommendations have been developed by a multidisciplinary group of health care professionals, patients and their representatives, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those with eating disorders while also emphasising the importance of the experience of care for patients and carers.

This guideline has been developed to advise on psychosocial interventions for drug misuse. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, service users, a carer and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for people who misuse drugs while also emphasising the importance of the experience of care for people who misuse drugs and their carers.

This guideline has been developed to advise on the management and support of children and young people on the autism spectrum. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, children and young people with autism, their carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for children and young people with autism while also emphasising the importance of the experience of care for children and young people with autism and their carers.

The study found that supervised person-centred care, communication skills and dementia-care mapping, as well as sensory therapy activities and structured music therapies, reduce agitation in care-home dementia residents. Health and social care costs were between £7000 and £15,000 depending on the severity of agitation. Further work is required to investigate interventions for agitation for use with people with dementia living in their own homes.

The study found that the Childhood obesity Outcomes Review (CoOR) outcome measures framework provides clear guidance of recommended primary and secondary outcome measures, which will enhance comparability between treatment evaluations and ensure that appropriate measures are being used.

To examine behavioral and pharmacological weight management interventions for overweight (defined as BMI ≥ 85th to 94th percentile of age- and sex-specific norms) and/or obese (BMI ≥ 95th percentile) children and adolescents which are feasible to conduct in primary care settings or that may be available for referral from primary care in order to update an identified gap in the previous report on childhood obesity for the United States Preventive Services Task Force (USPSTF).

To evaluate the effectiveness and comparative effectiveness of treatments for patients with binge-eating disorder (BED) and bariatric surgery patients and children with loss-of-control (LOC) eating. Studies of BED therapies include pharmacological interventions, psychological and behavioral interventions, or combinations of approaches. We examined whether treatment effectiveness differed in patient subgroups and described course of illness for BED and LOC eating.

This guideline has been developed to advise on the identification, treatment and management of obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). Although distinct disorders, OCD and BDD share a number of common features and there is a high degree of similarity between the treatments for the two conditions. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, people with OCD, a carer and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those with OCD and BDD while also emphasising the importance of the experience of care for people with OCD, BDD, and carers.

To examine available behavioral, pharmacological, and surgical weight management interventions for overweight (defined as BMI ≥ 85th to 94th percentile of age and sex-specific norms) and/or obese (BMI ≥ 95th percentile) children and adolescents in clinical and nonclinical community settings.

Obesity is a major health hazard and despite lifestyle modification, many patients frequently regain any lost body weight. The use of western anti-obesity drugs has been limited by side effects including mood changes, suicidal thoughts, and gastrointestinal or cardiovascular complications. The effectiveness and safety of traditional Chinese medicine including Chinese herbal medicine (CHM) and acupuncture provide an alternative established therapy for this medical challenge. In this systematic review, we used standard methodologies to search, review, analyse and synthesize published data on the efficacy, safety and relapse of weight regain associated with use of CHM and acupuncture. We also examined the rationale, mechanisms and potential utility of these therapies. A total of 12 electronic databases, including Chinese, English, Korean and Japanese, were searched up to 28 February 2010. Randomized controlled trials (RCTs) for CHM and/or acupuncture with comparative controls were considered. We used the Jadad scale to assess methodological qualities, the random effect model in the pooled analysis of therapeutic efficacy to adjust for heterogeneity and funnel plots to explore publication bias. After screening 2,545 potential articles from the electronic databases, we identified 96 RCTs; comprising of 49 trials on CHM treatment, 44 trials on acupuncture treatment and 3 trials on combined therapy for appraisal. There were 4,861 subjects in the treatment groups and 3,821 in the control groups, with treatment duration ranging from 2 weeks to 4 months. Of the 77 publications written in Chinese, 75 had a Jadad score <3, while 16 of the 19 English publications had a Jadad score of >3. Efficacy was defined as body weight reduction ≥ 2 kg or body mass index (BMI) reduction ≥ 0.5 kg/m(2) . Compared with placebo or lifestyle modification, CHM and acupuncture exhibited respective 'risk ratio' (RR) of 1.84 (95% CI: 1.37-2.46) and 2.14 (95% CI: 1.58-2.90) in favour of body weight reduction, with a mean difference in body weight reduction of 4.03 kg (95% CI: 2.22-5.85) and 2.76 kg (95% CI: 1.61-3.83) and a mean difference in BMI reduction of 1.32 kg m(-2) (95% CI: 0.78-1.85) and 2.02 kg m(-2) (95% CI: 0.94-3.10), respectively. Compared with the pharmacological treatments of sibutramine, fenfluramine or orlistat, CHM and acupuncture exhibited an RR of 1.11 (95% CI: 0.96-1.28) and 1.14 (95% CI: 1.03-1.25) in body weight reduction, mean difference in body weight reduction of 0.08 kg (95% CI: -0.58 to 0.74) and 0.65 kg (95% CI: -0.61 to 1.91), and mean difference in BMI reduction of 0.18 kg m(-2) (95% CI: -0.39 to 0.75) and 0.83 kg m(-2) (95% CI: 0.29-1.37), respectively. There were fewer reports of adverse effects and relapses of weight regain in CHM intervention studies conducted in China than studies conducted outside China. CHM and acupuncture were more effective than placebo or lifestyle modification in reducing body weight. They had a similar efficacy as the Western anti-obesity drugs but with fewer reported adverse effects. However, these conclusions were limited by small sample size and low quality of methodologies.

The authors concluded that no treatment had sufficient evidence to recommend broad clinical usage. The review had some methodological weaknesses, but the authors’ conclusions were suitably cautious and appear appropriate.

This review assessed interventions to control weight gain in patients with schizophrenia. The authors concluded that dietary and exercise counselling as part of a behavioural modification programme can control weight, but that widespread use of pharmacological interventions cannot be recommended. However, the behavioural intervention studies were of a poor quality, thus the evidence for implementation is weak.

The review evaluated the effectiveness of pharmacotherapy for binge-eating disorder and found some pharmacotherapies reduced short-term binge-eating and gave a limited weight loss. Combination of antiepileptic or anti-obesity drugs with cognitive or behavioural therapy did not reduce binge-eating, but modestly enhanced weight loss. Limited evidence for individual drugs and review process limitations make the reliability of the authors’ conclusions unclear.